The gynecological examination — compromising position, cold speculum, occasional cringey swab — has been an integral and infamous part of women’s health care in some form since around the 19th century. Traditionally performed in healthy women as a screening tool for several conditions, like gynecologic cancer, infections, and pelvic inflammatory disease — the gynecological exam is undergoing an overhaul, based on new data on its effectiveness and women’s comfort.
The annual rite was finally questioned in 2012, when new guidelines from the American Cancer Society and other health associations suggested that a part of the exam called the Pap smear — a test for cervical cancer screening — should no longer be annual, but done in intervals of three to five years. That move sparked debate over another part of the exam: If a woman is not due for her Pap test, and not experiencing any symptoms of gynecological disease, should she still be subjected to a yearly pelvic exam?
The age-old routine
During a pelvic exam, a woman lies on her back on an examination table while wearing nothing but a hospital gown. She’s then asked to slide her buttocks to the edge of the table and place her feet in stirrups. With her knees bent and legs spread apart, the provider begins the visual component of the exam by observing the vulva, looking for rashes and lesions.
The second part of the exam involves the use of the speculum, a metal or plastic duck-billed device. The clinician inserts the speculum into the vagina and open its blades to push the vaginal walls apart and get a view of the cervix, the lower part of the uterus that lies at the deep end of the vagina. At this point, samples can be swabbed from the cervix if the woman is due for her Pap test.
The final step is called the bimanual examination. After removing the speculum, the clinician places their index and middle finger into the vagina while using the other hand to press the abdominal organs and feel the size and shape of the uterus and ovaries. Finally, the clinician may do a…